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It is up to you

9th September 2006

09092006_confusion1.jpg'Here you are madam, this is your cancer. Now, how would you like us to treat it?' 

Yes, admittedly health care professionals are working in a type of service profession, but deciding on a cancer treatment is not quite the same as deciding on whether you want your steak rare, medium or well done.  Of course, you know you want it ‘done with’, but as most cancer patients are faced with such a decision for the first time in their life, they are often ill prepared for having any useful input into exactly how to get it over and done with as quickly and safely as possible.

The recent article in hc2d – reporting on a study by Ziebland et al. and funded by Cancer Research UK – highlighted the confusion that cancer patients can often feel when offered a choice of treatment options for their illness.

I think there are many areas in health care where it has been hugely beneficial to adopt a more ‘customer oriented’ approach in order to improve patient centred care.  However, as in all processes of change, there is a danger of going from one extreme – where a paternalistic doctor tells you what will happen - to the other extreme – total reliance on patient autonomy and leaving the decision to the patient.  What was meant to demonstrate respect for the patient, ensure personal integrity and stimulate patient participation could so easily become a burden to the patient of making non-informed choices.   

Don’t get me wrong, I am an eager advocate of ‘Power to the patient’, and patient empowerment and choice are extremely important and justifiable components in current health care policies.  However, power is only positive and useful if we have the appropriate tools in order to execute that power in our best interest.  In the context of treatment decision making, required ingredients would be information, knowledge, a time slot conducive for discussion and good communication in the patient / doctor relationship. It is therefore crucial that if we focus on the model of ‘informed choice’, we stress the importance of being truly ‘informed’ before expecting that choice.  Alternatively, we could take a step back from the ‘informed choice’ model and practice the ‘shared decision-making’ model.  Here we still have an informed patient, but the choice is not a burden to be carried by the patient alone at a time when they are likely to be traumatised and not in the best position to make vital decisions about life or death. 

The bottom line is whichever choice we make, it is our duty to allow those who want to choose their treatment to do so – whilst at the same time acknowledging that offering a real choice means respecting those who choose not to make that choice.

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